Provider Demographics
NPI:1730997875
Name:FOWLER, KYLE BRUCE (PA-C)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:BRUCE
Last Name:FOWLER
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:7815 S 196TH ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-5036
Mailing Address - Country:US
Mailing Address - Phone:719-453-6568
Mailing Address - Fax:
Practice Address - Street 1:4021 AVENUE B
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4602
Practice Address - Country:US
Practice Address - Phone:308-630-1947
Practice Address - Fax:308-630-1439
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical